Drugs & Aging最新文献

{"title":"Factors Influencing Hospital Physicians' Recognition of Prescribing Cascades: A Qualitative Interview Study.","authors":"Ruth Daunt, Kieran Dalton, Denis Curtin, Denis O'Mahony","doi":"10.1007/s40266-025-01222-4","DOIUrl":"https://doi.org/10.1007/s40266-025-01222-4","url":null,"abstract":"<p><strong>Introduction: </strong>A prescribing cascade occurs when a medication is prescribed to manage a side effect of another medication. Prescribing cascades represent a key component of problematic prescribing and can result in harm to patients, especially older adults with multimorbidity and polypharmacy.</p><p><strong>Objective: </strong>The objective of this study was to explore factors influencing hospital physicians' recognition of prescribing cascades using the Theoretical Domains Framework (TDF), a validated theory-based qualitative methodology.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted in May-July 2024 with hospital physicians of all grades. Interviews were audio-recorded and transcribed verbatim. Transcripts underwent conventional and directed content analysis to identify themes and TDF domains.</p><p><strong>Results: </strong>From 14 interviews, four predominant TDF domains were identified: (i) environmental context and resources: busy work conditions, lack of up-to-date medication lists and limited information technology (IT) infrastructure hinder prescribing cascade recognition; (ii) knowledge: physicians demonstrated limited knowledge of the term 'prescribing cascade' and highlighted education and training deficiencies at undergraduate and postgraduate level; (iii) skills: recognition skills are often developed through experiential learning while working (especially with geriatric medicine consultants) and (iv) social/professional role and identity: physicians perceived themselves as primarily responsible for recognising prescribing cascades, while pharmacists enable their recognition through medication reconciliation, medication review and ward round participation.</p><p><strong>Conclusions: </strong>This study highlights significant gaps in the knowledge and understanding of prescribing cascades among hospital physicians, as well as potential targets for future intervention. Focused education, integrated IT solutions, and a collaborative physician-pharmacist approach would likely improve prescribing cascade recognition in at-risk older people with multimorbidity and polypharmacy.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors for Psychotropic Medication Use in Older Adults in Australia: A Nationwide Data Linkage Study.","authors":"Hieu T Le, Edward C Y Lau, Weisi Chen, Christine Y Lu, Tuan A Nguyen, Lee-Fay Low, Sarah N Hilmer, Yun-Hee Jeon, Edwin C K Tan","doi":"10.1007/s40266-025-01220-6","DOIUrl":"https://doi.org/10.1007/s40266-025-01220-6","url":null,"abstract":"<p><strong>Background and objectives: </strong>Psychotropic medications are associated with an increased risk of adverse drug events in older adults, yet national data on their use in Australia remain limited. This study aims to estimate the prevalence of psychotropic medication use among older Australians and to examine the sociodemographic factors associated with their use.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted using national linked data from the 2021 Census and the Pharmaceutical Benefits Scheme (PBS). The study included all individuals aged 65+ years who responded to the 2021 Census and received at least one PBS medication between 1 August and 31 October 2021. Prevalence of psychotropic medication use was calculated across 5-year age groups, and sociodemographic factors associated with each psychotropic subclass were assessed by logistic regression model.</p><p><strong>Results: </strong>Among the 3,850,281 older adults, 31.1% received at least one psychotropic medication. Prevalence increased with age across all subclasses except antiepileptics. Antidepressants were the most commonly used psychotropics (19.9%). Those needing assistance with core activities (odds ratio, OR 2.05, 95% confidence intervals, CI 2.03-2.06) and living in non-private dwellings (OR 2.02, 95% CI 1.99-2.05) were more likely to receive psychotropics. Conversely, higher educational level, socioeconomic status and non-English speaker were associated with a lower use of all psychotropic subclasses. Aboriginal and Torres Strait Islander people were linked to increased use of benzodiazepines (OR, 1.15; 95% CI 1.10-1.20) and opioids (OR, 1.20; 95% CI 1.16-1.23). Dementia was strongly associated with antipsychotic (OR, 2.59; 95% CI 2.52-2.66) and antidepressant (OR, 1.42; 95% CI 1.40-1.44) use. Arthritis significantly increased the likelihood of opioid use (OR, 2.03; 95% CI 2.02-2.05).</p><p><strong>Conclusions: </strong>Almost one third of the study population used psychotropic medications between August and October 2021. Aboriginal and Torres Strait Islander people, individuals with dementia and those with arthritis had an increased likelihood of using certain psychotropic medications. Future research should evaluate the clinical appropriateness of psychotropics in these populations, with immediate implementation of strategies to ensure that their use is limited to evidence-based indications.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incontinence-Associated Dermatitis in Older Adults: A Critical Review of Risk Factors, Prevention and Management.","authors":"Jan Kottner, Joachim Dissemond","doi":"10.1007/s40266-025-01227-z","DOIUrl":"https://doi.org/10.1007/s40266-025-01227-z","url":null,"abstract":"<p><p>Prolonged and repeated exposure of the skin to urine and/or faeces may lead to incontinence-associated dermatitis (IAD). IAD is an irritant contact dermatitis characterised by pain, erythema, maceration, erosion, scaling and very often associated with secondary infection. Older adults who are incontinent are at high IAD risk. Several differential diagnoses must be separated from IAD, with allergic contact dermatitis being the most common in older people. The main prevention and treatment principles are to reduce or to avoid the exposure of the skin to urine and stool. The type of incontinence should be assessed first and strategies to enhance continence implemented. Especially in older adults, high absorbency incontinence products should be used and changed regularly to reduce overhydration of the epidermis. Protective skin care products and mild cleansing should be applied. Weeping erosions, excoriations or infection should be treated with appropriate topical products. The short-term and controlled use of corticosteroids or external urine or stool collection devices or indwelling urinary catheters might be considered in severe cases. Owing to demographic changes, the management of incontinence and associated IAD will become more important. This will be especially relevant in primary care for older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drugs and Healthy Aging.","authors":"Sarah N Hilmer, Luigi Ferrucci, Antonio Cherubini","doi":"10.1007/s40266-025-01208-2","DOIUrl":"https://doi.org/10.1007/s40266-025-01208-2","url":null,"abstract":"<p><p>Appropriate drug treatment can enhance the likelihood of experiencing healthy aging and maintaining functional ability up to very late in life. Strong evidence exists that overall drugs can help prevent and manage diseases. However, such evidence is mostly available from studies that are not representative of older people and do not include functional/well-being outcomes. Therapeutic drugs can also impair physical and cognitive function and social interactions, particularly in the context of polypharmacy, multimorbidity and frailty. Certain drugs can affect the ability to exercise and consume a healthy diet, which are key nonpharmacological interventions that promote healthy aging. Yet, exercise and nutritional interventions can help manage adverse drug reactions. In the future, drugs (gerotherapeutics) may be developed that slow the aging process, which should prevent or delay the incidence and progression of many chronic diseases, improving healthy aging.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review.","authors":"Oriane Adrien, Atiya K Mohammad, Jacqueline G Hugtenburg, Lisa M McCarthy, Simone Priester-Vink, Robbert Visscher, Patricia M L A van den Bemt, Petra Denig, Fatma Karapinar-Carkıt","doi":"10.1007/s40266-025-01213-5","DOIUrl":"https://doi.org/10.1007/s40266-025-01213-5","url":null,"abstract":"","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Psychedelic Agents in Older Adults with Treatment-Resistant Major Depressive Disorder: What the Evidence Shows.","authors":"Lou Vinarcsik, Charles Smoller, George Grossberg","doi":"10.1007/s40266-025-01221-5","DOIUrl":"https://doi.org/10.1007/s40266-025-01221-5","url":null,"abstract":"<p><p>The use of drugs with psychedelic and dissociative effects for the treatment of psychiatric illnesses has become increasingly popular in recent years. However, few trials have been conducted to determine the efficacy of these agents in the specific setting of treatment-resistant major depressive disorder (MDD) in older adults. In this paper, we review notable aspects of treatment-resistant MDD in older adults, review classical and nonclassical psychedelic agents and dissociative agents presently being trialed mostly in younger populations for the treatment of depression, and review what is known about trialing these agents in older adults with treatment-resistant MDD. Given the limitations to extant standard treatment and the potential risks associated with first-line pharmacological agents such as selective serotonin reuptake inhibitors (SSRIs) in this population, psychedelic-assisted psychotherapy may offer an important alternative for managing treatment-resistant MDD in older adults. This subset of patients is understudied and stands to benefit significantly from improved treatment regimens. The limited research available that details psychedelic-assisted treatment in this specific group is promising. Here we focus on reviewing those agents with the most controlled data available, beginning with the dissociative anesthetic ketamine/esketamine, and the hallucinogenic agent psilocybin, and concluding with a brief review of related substances including lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), ayahuasca, ibogaine, 3,4-methylenedioxymethamphetamine (MDMA), and mescaline. Treatment-resistant MDD is highly prevalent among older adults, and while preliminary findings seem promising regarding the safety and tolerability of psychedelics, concerns remain owing to insufficient data, and therefore further research is crucial to establish the safety, efficacy, and applications of psychedelic therapy in this population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Gabapentinoid Use and Changes in Claims-Based Frailty Among Long-Term Opioid Users.","authors":"Jordan Westra, Mukaila Raji, Jacques Baillargeon, Rajender R Aparasu, Yong-Fang Kuo","doi":"10.1007/s40266-025-01216-2","DOIUrl":"https://doi.org/10.1007/s40266-025-01216-2","url":null,"abstract":"<p><strong>Objective: </strong>Assess the association of opioids and gabapentinoids with changes in frailty among Medicare beneficiaries who used opioids for 90 or more consecutive days.</p><p><strong>Methods: </strong>Using a Medicare sample between 2014 and 2020, this study included long-term opioid users who were eligible for Medicare parts A, B, and D for 3 years and had no prior gabapentinoid use. The study was broken into three 1-year periods: lookback, exposure, and outcome. The exposure of interest was gabapentinoid and opioid use measured in period 2. The primary outcome was difference in frailty between periods 1 and 3. Linear regression was used to assess the difference in frailty change by gabapentinoid and opioid use. Multinomial regression was also used to assess the odds of categorical frailty change by gabapentinoid and opioid use.</p><p><strong>Results: </strong>Overall, the changes in frailty between assessment periods were small. Those who had no continued opioid/no gabapentinoid use showed decreases in frailty (- 0.0005), while each of the other three groups increased in frailty between the assessment periods (opioids only, 0.0040; gabapentinoids only, 0.0136; opioids + gabapentinoids, 0.0142). In addition, each of the drug groups showed increased odds for large increases in frailty compared with those who had no continued opioid/no gabapentinoid use (opioids only, odds ratio (OR): 1.25, 95% confidence interval (CI) 1.04-1.49; gabapentinoids only, OR: 3.12, 95% CI 1.75-5.55; opioids + gabapentinoids, OR: 2.30, 95% CI 1.85-2.87).</p><p><strong>Conclusions: </strong>Using gabapentinoids, opioids, or a combination of the two showed greater increases in frailty compared with those who used neither drug after long-term opioid use.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scabies in older adults: What Is New in Diagnosis and Treatment?","authors":"Vasiliki Kourouni, Callum D Verran, Jonathan P E White, David J Chandler","doi":"10.1007/s40266-025-01219-z","DOIUrl":"https://doi.org/10.1007/s40266-025-01219-z","url":null,"abstract":"<p><p>Scabies is a common and disabling ectoparasitic infestation of the skin that can clinically present in 'classical' or 'crusted' forms. Diagnosis can often be made on the basis of clinical history and careful dermoscopic examination of the skin. The International Alliance for the Control of Scabies (IACS) diagnostic criteria can support the diagnosis and management of patients with suspected scabies. Older adults are a vulnerable population; the clinical presentation of scabies can be atypical in this group and treatment can be challenging. Institutional scabies outbreaks, such as in care homes, are typically challenging to identify and, therefore, subject to diagnostic delay. These outbreaks are hard to control and an important source of morbidity, requiring simultaneous treatment of those affected, which can be complicated and time consuming. The management of scabies outbreaks involves repeated, contemporaneous (if multiple individuals) treatments with topical scabicide applications to the whole body, with decontamination of the environment(s). In some situations, topical treatment may be inappropriate and delay effective treatment.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Harm Reduction of Metformin Plus DPP4 Inhibitors versus Metformin Plus Sulfonylureas in Older Adults: A Target Trial Emulation Using German Claims Data.","authors":"Paula Starke, Petra Thürmann, Thomas Grobe, Tim Friede, Tim Mathes","doi":"10.1007/s40266-025-01218-0","DOIUrl":"https://doi.org/10.1007/s40266-025-01218-0","url":null,"abstract":"<p><strong>Objective: </strong>This study complements evidence from randomized controlled trials on the harms (e.g., hypoglycemia) of sulfonylureas compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in the treatment of type 2 diabetes in older adults using real-world data. Existing evidence suggests an increased risk of hypoglycemia, falls, fractures, and cardiovascular events.</p><p><strong>Methods: </strong>Using target trial emulation, we analyzed a retrospective cohort drawn from German routine claims data. We included patients older than 65 years who initiated DPP4i (sitagliptin, vildagliptin, or saxagliptin) or sulfonylureas (glibenclamid or glimepirid) as add on to metformin between 2011 and 2018. Confounding was adjusted for through overlap weighting, and the average treatment effects were estimated in the overlap population using generalized linear models.</p><p><strong>Results: </strong>Among 171,318 eligible patients, 111,865 (65%) received DPP4i and 59,453 (35%) sulfonylureas. Patients treated with DPP4i had a higher prevalence of all observed comorbidities. Applying overlap weights to adjust for confounding, patients treated with DPP4i had a higher rate of combined all-cause hospitalizations and outpatient visits compared with those treated with sulfonylureas (rate ratio = 1.03, 95% CI 1.02-1.03) in the total population. In contrast, we found a protective effect of DPP4i on the risk for severe hypoglycemia in the subgroups of new users (ratio rate (RR) = 0.51, 95% CI 0.33, 0.76) and patients with severe renal insufficiency (RR = 0.31, 95% CI 0.16, 0.61).</p><p><strong>Conclusions: </strong>Deprescribing sulfonylureas and using DPP4i instead may slightly reduce harm in some subgroups of older adults, which supports recommendations of existing lists of potentially inappropriate medications.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprescribing Antipsychotics and Proton Pump Inhibitors in Long-Term Care: A Prescribing Portraits Approach.","authors":"Nooreen Haji, Aaron M Tejani, Anthony Tung, Ying Wang, Deborah Heidary, Wade Thompson, Carolyn Bubbar","doi":"10.1007/s40266-025-01217-1","DOIUrl":"https://doi.org/10.1007/s40266-025-01217-1","url":null,"abstract":"<p><strong>Introduction: </strong>Antipsychotics (APs) and proton pump inhibitors (PPIs) are commonly prescribed in long-term care (LTC) despite potential risks with prolonged use.</p><p><strong>Objective: </strong>This study evaluates the frequency of AP and PPI prescriptions and assesses the impact of \"prescribing portraits\" on deprescribing in LTC residents at 2 LTC facilities in British Columbia.</p><p><strong>Methods: </strong>This multicenter, prospective quality improvement (QI) study was conducted at two LTC homes: Holy Family Hospital (site A) and Queen's Park Care Centre (site B). The QI approach involved collecting data on prescribing appropriateness, implementing a real-time intervention, and tracking its impact. Prescribing portraits-personalized reports detailing individual prescribing patterns, evidence-based indications, and deprescribing recommendations-were presented to prescribers by clinical pharmacists. The primary outcomes were the proportion of prescriptions eligible for deprescribing and the deprescribing rate at 3 months post-intervention.</p><p><strong>Results: </strong>At site A, 21 of 48 residents receiving AP were identified as eligible for deprescribing, with 31.6% receiving deprescribing orders within 3 months. Among 12 residents previously assessed in our earlier QI study at site A who remained on PPIs, 33% were newly deprescribed after reassessment in this study. At site B, 23 of 48 residents on antipsychotics were eligible, with a deprescribing rate of 20%. For PPIs, 31 of 38 residents were considered eligible at site B, and 36% had deprescribing orders initiated.</p><p><strong>Conclusions: </strong>Integrating prescribing portraits into multidisciplinary medication reviews promotes appropriate deprescribing of APs and PPIs in LTC, encouraging safer prescribing practices and improving medication safety.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}